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Hyposplenism and Splenectomy

Background Knowledge ๐Ÿง 

Definition

  • Hyposplenism: Reduced splenic function, leading to diminished immune response against certain pathogens.

  • Splenectomy: Surgical removal of the spleen.

Causes of Hyposplenism

  • Autoimmune conditions: e.g., Systemic lupus erythematosus (SLE), rheumatoid arthritis.

  • Haematological diseases: e.g., Sickle cell disease, thalassaemia, hereditary spherocytosis.

  • Infiltrative diseases: e.g., Sarcoidosis, amyloidosis.

  • Post-splenectomy

Indications for Splenectomy

  • Trauma with splenic rupture.
  • Haematological conditions: e.g., Immune thrombocytopenia (ITP), hereditary spherocytosis.
  • Non-responsive splenomegaly.
  • Masses or cysts within the spleen.

Investigations ๐Ÿงช

Investigations

  • Blood smear: Presence of Howell-Jolly bodies (nuclear remnants in RBCs) indicates hyposplenism.

  • Imaging: Ultrasound or CT scan for spleen size and morphology.

Management ๐Ÿฅผ

Management

  • Vaccination: Before elective splenectomy, vaccinate against encapsulated organisms (pneumococcal, meningococcal, and H. influenzae type b vaccines).

  • Consider prophylactic antibiotics post-splenectomy, especially in children and for at least 2 years after surgery or lifelong in certain cases.

  • Education: Advise patients about the risk of infection and to seek immediate medical attention for febrile illnesses.

Prevention

  • Vaccination is key for preventing severe bacterial infections.

  • Routine check-ups to monitor for complications.

  • Prompt treatment of infections with broad-spectrum antibiotics.

Complications

  • Overwhelming post-splenectomy infection (OPSI): Severe infection due to encapsulated bacteria (e.g., Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis).
  • Thromboembolism: Increased risk of portal or mesenteric vein thrombosis.
  • Atelectasis and pneumonia: Due to restricted diaphragmatic movement post-surgery.
  • Wound infection.

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